Homestead_Munford�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�, ._. 4 STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 609)
�O ,��� 1 Preuribed by Ne DepaM1ment of Local Govemmenl Friance
INSTRUCTIONS: See reverse side for filing instructions.
�� YEAR
FORM �
HC70
I(We) � / L.� certify u�ylWLwef�cQ�P��gmY (our) prindpal
place o( residence or a re) buying Ihe following described real pro for which a Homestead Property Tax Standard Deduclion is hereby daimed
under coniract on �he da e Ihis applica�ion is filed, (date of filing): �� �,/
❑ I(We) own ❑ Am (are) buying under recorded conVact �
❑ Am (are) enliUed to occupy as a[enanbstockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR
� Have a benefidal interest in �he Wst or Ihe right to occupy ihe property under the tertns of a quali(ed personal residence Wst
Name of da' �(! I namej
I
Sodal Sertvi nu��ber of ' st frve d'g3c)
name)
Saial Securiry number of Uaimam's spouse (last five di
II Euyi� om m�trad, Fee Simple owners name
RemMefs office where mnVaU is recdded
Township
qercel numher Legal des
If any
or me
Counry
ol tlaimant (last
�
D`ivers license / IdrnGfration / Othrr number
ot daimanPs spouse (lest five tllgits)
-o�-I o►-ool .� �a-v a-t
f ihe revdenllal sWCWra or Ihe IaM nol exceedinB �e (1) arfe
uuT¢e0 tu potlure inmme.
Township
I hereby certify the a6ove statements are we, cortect and complete.
Pddress (number antl sLeel, tiy, sfate, antl Z1PCOde)
Lantl
acre immetliately
Other land
Total land (line 1 plus line �
Residenllal Improvements or M
Ass�sed Mobik I Manutactured
Other imOrovemen5
Dwelling
Ga2ge
Tofal improvementa (Ilne 4 throug� Ilne �
7ota1 value (line J p/'s line 7�
I herehy certify ihe above is We, cortect,
and camplete.
VeliNin9 ad'mn - SignaNre o(lwditar
.
(�)
(2)
(3)
(4)
(5)
(6)
Sig(aNre
Tax'vg Gistricl (ciN•
�v��y �� ���
IsSU"vg $lata
Recad number
Page
proPerty in Cues6an: �
�eal property ❑ AnnuaDy assessed mohile home (IC G7.1-;
that sWCNre is used m produce iMbne, des�ibe the use aM por0on
of daimant
20 _ pay 20 Lesser of 60% of the assessed value of ihe homestead or $45,000
NofwilhslaMing any olher piovisbn, Ne sum of Me tleducfions provided in IC 61.1-12 to a mobAe home Nat @ $
not assessetl as real property w ro a rrem�faUUred home Net is int assessed as real p2peM meY rat exceed
wre-hallf121 W Ne assessed value d Ne mob�e frome ormanuhtturetl �ame.
Date slgned (monfh. EaY. Y��
Daie signetl (rtanN, day, yea�
�